儿童失神癫痫与儿童良性癫痫伴中央颞区棘波共存患者的临床分析

Simultaneous or sequential onset of childhood absence epilepsy and childhood benign epilepsy with centrotemporal spikes:a VEEG and clinical feature study

目的探讨儿童失神癫痫(CAE)与儿童良性癫痫伴中央颞区棘波(BECTS)共存患者的视频脑电图(VEEG)和临床特征。方法选择首都医科大学附属北京天坛医院神经病学中心自2016年1月至2023年7月收治的7例CAE与BECTS共存患者,回顾性分析其临床资料、VEEG、治疗和预后情况。检索PubMed数据库中自2002年1月至2023年7月关于CAE与BECTS共存患者的文献,纳入包含3例及以上CAE与BECTS共存患者资料的研究,比较各研究间CAE与BECTS共存患者临床特点的差异。结果 (1)7例患者的平均发病年龄为6.28岁,范围为4~8岁。2例患者的临床表现为CAE,在疾病进展过程中没有出现BECTS临床表现。5例患者先后出现CAE、BECTS临床表现。7例患者中,2例患者使用丙戊酸钠单一药物治疗有效,5例患者需添加其他抗癫痫药物。尽管所有患者的癫痫发作控制良好,无发育迟缓,但3例患者合并注意力缺陷多动障碍(ADHD),3例患者合并学习障碍,2例患者合并焦虑。韦氏儿童智力量表-Ⅲ量表评估显示1例患者的智力为中下,6例患者的智力为中等。7例患者的VEEG均显示失神发作与中央颞区棘波同时或先后出现。(2)共纳入PubMed数据库中4项研究,结合本研究,5项研究中CAE与BECTS共存患者在CAE、BECTS发病年龄方面差异有统计学意义(P<0.05),但2种的VEEG表现是否同时出现、是否合并疾病方面差异均无统计学意义(P>0.05)。结论 CAE与BECTS共存患者的CAE、BECTS发病年龄不同,总体预后良好,对抗癫痫药物的反应也较好,但易合并认知障碍。

Objective To analyze the video electroencephalogram(VEEG)and clinical features of simultaneous or sequential onset of childhood absence epilepsy(CAE)and childhood benign epilepsy with centrotemporal spikes(BECTS).Methods Seven patients with simultaneous or sequential onset of CAE and BECTS admitted to Neurology Center,Beijing Tiantan Hospital from January 2016 to July 2023 were chosen.The clinical features,VEEG,treatments and prognoses of these patients were retrospectively analyzed.PubMed database was searched for articles on simultaneous or sequential onset of CAE and BECTS from January 2002 to July 2023,and studies with 3 or more cases of simultaneous or sequential onset of CAE and BECTS were included.Clinical characteristics of these patients in various studies were compared.Results(1)The mean onset age in these 7 patients was 6.28 years,ranged from 4 to 8 years.CAE was recorded in 2 patients without clinical manifestation of BECTS during the course of disease progression;simultaneous or sequential onset of CAE and BECTS was recorded in 5 patients.Of the 7 patients,2 effectively accepted valproate sodium(VPA)monotherapy,and 5 required additional antiepileptic drugs.Although all patients had well-controlled seizures and no developmental delays,3 had learning disabilities,3 had attention deficit hyperactivity disorder(ADHD),and 2 had anxiety.Wechsler Intelligence Scale for Children-III(WAIS-III)showed that 1 patient had below average intelligence and 6 had average intelligence.VEEG of all 7 patients showed simultaneous or sequential absence seizures and centrotemporal spikes.(2)Four studies were included in PubMed database.Combined with our study,these 5 sutdies indicated significant differences in onset age in patients with simultaneous or sequential onset of CAE and BECTS(P<0.05),but no significant differences in simultaneous VEEG manifestations occurred or not and disease comorbidities or not in CAE and BECTS patients(P>0.05).Conclusion Patients with simultaneous or sequential onset of CAE and BECTS have different onset age,good overall prognosis and good response to anti-epileptic drugs,and trend to have complicated cognitive impairment.